National PCC Day 2010

Miami-Dade County PCC

PCC of Broward County

PCC of the Palm Beaches

National PCC Day

DAVE & BUSTER's

3000 Oakwood Blvd.

Hollywood FL

Wednesday, September 15, 2010

8:30am to 1:30pm

$30.00 per person

(If paying by check at the door- $40.00 per person)

Lunch will be provided

To register for this event please fill out below.

Company Name: *
Attendee Name #1:
Attendee Name #2:
Attendee Name #3:
Attendee Name #4:
Attendee Name #5:
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email Address: *
Phone Number: - (###) - ### ####
Yes, I'd like to reserve a display table at the event for $75.00 each One table Two tables
National PCC Day 2010- Sponsor Package- $150 includes:
-Recognition at event
-Signage at event
-Sponsor mention on email blitzes
-Two admissions for PCC Day event Yes, my company would like to be a Sponsor for this event. Sponsor package includes two admissions, my company will need more at $30.00 per person
Payment Type:
$30.00 Per Person
$75.00 Display Table Only
$150.00 Sponsor Package * CREDIT CARD**PLEASE FILL OUT ALL NECESSARY CREDIT CARD INFORMATION BELOW** CHECK BY MAIL** PLEASE MAKE CHECK PAYABLE TO: Miami-Dade County PCC. MAIL PAYMENTS TO: Miami-Dade County PCC, PO Box 52-4216, Miami FL 33152-4216. PAYMENT MUST BE RECEIVED BY 9/1/10. CHECK AT THE DOOR** ($40 PER PERSON)**PLEASE NOTE, IF SELECTING THIS OPTION AND NOT MAILING IN YOUR CHECK BY 9/1/10 DEADLINE, PAYMENT AT THE DOOR WILL BE $40.00 PER PERSON
Credit Card Type: Mastercard Visa American Express
Credit Cardholder Name: First Last
Credit Card Number:
Credit Card Expiration Date: / MM / DD YYYY
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